Wine Club Signup FormWine Club Sign Up "*" indicates required fields Name* First Last Email* Phone*Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Application Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Shipping Address (if different than billing address) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Special InstructionsMembership Options* Cloud Wine (Standard with Local Pickup) ($81 + tax per quarter) Sweet Child of Wine (Standard with Shipping) ($106 + tax per quarter) Between the Wines (Custom with Shipping) ($116 + tax per quarter)) ANNUAL with Local Pickup ($324 + tax annually) ANNUAL with Shipping ($369 + tax annually)Add VIP level?* Yes NoAdd VIP Level (additional $44 per quarter or $176 annually) and receive: 2 nights free annually in one of our 1 bedroom units 4 days 5 nights free annually in our RV ParkCredit Card #1*Your card will not be charged until the 25th of the following quarter month from sign up date. Quarter Months are March, June, September, and DecemberCard Details Cardholder Name Second CardCard NumberCardholder NameMM/YYCVV Add RemoveDebit OR Credit - Used only if primary card fails. TERMS: When you sign up for the wine club membership you contractually agree to buy 12 bottles of wine for a minimum of one year that is sold annually OR at the end of each quarter month: March, June, September, and December. Your membership at the first quarter month-end following your application date. When you purchase wine while visiting our vineyard between quarters it will not count towards your quarterly purchase. However, your 10% discount will apply. Wine Clube Cancellations: 1. Must be made by email to RRVdesk@gmail.com and must be sent 30 days before the end of the quarter month 2. If you have met our 12-bottle annual requirement there is no cancellation fee 3. If you have not met your 12-bottle requirement there will be a cancellation fee of $30 + NC tax= $32.10CAPTCHAEmailThis field is for validation purposes and should be left unchanged. PLEASE NOTE: Due to individual state laws, we are unable to ship to the following states: AL, AR, DE, KS, KY, MN, MD, MS, MT, NJ, OK, PA, RI, SD, TN, UT, VT.